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Time-release delivery is the future of allergy management
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Today marked a milestone. My 2010 Saab turned over 100,000 miles. While I’m sure many of you are thinking, “What’s this guy doing driving a 7-year-old Saab?” the answer is simple. I love this car. It is well built (think winter in Rochester), a model of engineering efficiency, incredibly responsive (Saab pioneered the turbo) and really fun to drive.
For me, the latter has always been a priority, as I think of driving as much more than just getting from point A to B. It is a participation sport, one in which the driver plays an integral role. For this reason, every car I have owned, present Saab included, has had a manual transmission. Nothing gives one a better sense of engagement than a good old clutch – which, unfortunately, is proving to be a sticking point.
I am not naïve. My car will not last forever, and, as Saabs are no longer built, I have started looking at alternatives. The problem is that many auto manufacturers no longer offer a manual transmission. At first, I found this incredulous. I mean, how could the driving public have become so complacent as to find a third pedal too much to work with?
As it turns out, it is not just driver indifference, it is also auto makers themselves who are driving this trend. While it is true a manual transmission does not align with the concept of a self-driving car, the real reason for the shift (no pun intended) actually lies in performance. You see, technology has evolved to the point where an eight-speed, dual clutch, automatic transmission can get me from point A to B quicker than I can on my own. In fact, my participation is likely to be counterproductive. Ouch.
In many respects, I sense we are on the verge of a similar shift in how we will manage ocular allergies. While our time-honored six speeds of allergy management – avoidance, lubrication, cool compresses, topical antihistamine/mast-cell stabilizers, topical corticosteroids and oral immunomodulation – have served us well, there is still room for improvement.
Certainly, we all see patients who, despite maximal allergy management, still suffer mightily and eventually become noncompliant. We, of course, find this incredulous. After all, how difficult can it be to take an oral antihistamine once a day and an eye drop once or twice a day? It is that whole “How difficult can it be to drive a manual?” thing again.
The reality is we cannot always blame therapeutic failure on patient noncompliance, and perhaps it is time for us to rethink just what constitutes an optimal mode of drug delivery. Given the chronic, fulminating nature of ocular allergy inflammation, the solution likely lies in sustained, time-release drug delivery. Unlike the highly variable drug availability associated with aqueous eye drops, newer technologies promise a more prolonged pharmacologic response.
Depot punctal plugs, emulsion sprays and drug-eluting contact lenses all support this directive – each enhancing compliance by providing a better therapeutic solution. Think of it as a better way to get from point A to B.
This month’s feature article, “Future ocular allergy drug delivery methods may eliminate compliance issues” provides an exceptional overview of what the future of ocular allergy management looks like. While it will take time for us to shift our management strategies, the endpoints, in all likelihood, will be better than our current approach. As we embark upon this journey we must keep one thing in mind: it is our patients who drive change.